People with diabetes and peripheral neuropathy (DM+PN) have substantial lower extremity impairments, functional limitations and disability. In addition to muscle weakness and poor balance, they also are at high risk for foot ulcerations, especially if they have a history of ulceration. Exercise is an important treatment component to help control the complications of diabetes. The American Diabetes Association and the American College of Sports Medicine recommend that adults with DM participate in at least 30 minutes a day of moderate-intensity physical activity that is consistent with a brisk walk. However, these groups discourage weight-bearing exercise for people with DM+PN due to risk of exercise-induced foot injury. Little data exists on the effect of exercise on people with DM+PN and no data support the restriction to limit weight bearing exercise in those with DM+PN. The Primary Goal of this proposal is to conduct a pilot randomized prospective controlled clinical trial to determine if people with DM+PN can benefit from a progressive weight-bearing exercise program (compared to a non weight bearing exercise program and a non exercising control group) without an increase in skin breakdown or foot lesions. Outcomes are included from measures of pathophysiology, impairments, functional limitations, and disability. The results of this study will help to determine if neuropathic skin and muscle can adapt to increasing physical stress levels without injury, and could have important implications for weight- bearing and exercise guidelines for people with DM+PN. PUBLIC HEALTH RELEVANCE: People with diabetes and peripheral neuropathy have substantial problems with weakness, stiffness, and insensitivity in their legs that result in problems with skin breakdown, balance, functional mobility (walking and stair climbing) and participation in community activities. Exercise has been shown to help these mobility problems in people with diabetes, but has not been tested in people who also have peripheral neuropathy. The Primary Goal of this proposal is to conduct a pilot randomized prospective controlled clinical trial to determine if people with diabetes and peripheral neuropathy can benefit from a progressive weight-bearing exercise program without an increase in skin breakdown or foot lesions. The benefits of a weight bearing exercise program will be compared to the benefits of a non weight bearing exercise program and a non exercising control group. The results of this study would have important implications for weight-bearing and exercise guidelines for people with diabetes and peripheral neuropathy.